Despite promising anti-retroviral treatments for fighting HIV, poor adherence to medication ranks as a major cause of treatment failure and emerging drug resistance. The proposed anthropological project will examine African Americans living with HIV and their cultural experience of adhering to HAART over time. It will contribute data on adherence practice within the larger context of the patient's life. It will also advance our knowledge about African Americans, a group with the highest incidence and death rates from HIV. The goal of the proposed 5-year study is to identify and describe the evolution of patient adherence practices and understandings as located in the wider setting of daily living with HIV. We propose to follow the lives of 150 HIV+ African Americans in Detroit, each for three years using a two group design to represent key periods over the span of the HAART patient experience. Building on the lived experience perspective, we will provide in-depth data on personal and cultural beliefs, motives, and rationales associated with adherence and non-adherence practices. One strength of the study design is that it allows us to examine how the patient's own definition of the course, stages and critical transitions in adherence relate to relationships, experiences, and influences and culturally salient sources of support for and barriers to sustained HAART adherence. The study will contribute to understanding the challenges of and resources for adhering to complex medical regimens over time by studying HIV+ African Americans adhering to HAART. The improved understanding of adherence patterns and variability may help clinicians to anticipate adherence difficulties and develop interventions to enhance those factors that support adherence. Basic knowledge created by the proposed study may lead to research that integrates the patient's perspective into effective interventions for improving adherence. The study is characterized by the innovative use of emerging paradigms of the social science approach to improving adherence.